ANN ARBOR, Mich. U.S.: In a recent study, a researcher from the University of Michigan has assessed the impact of adverse childhood events, such as childhood trauma, abuse and smoking, on oral health later in life. The study reported that, even if children grow up to overcome childhood adversity, the trauma they experience in early life puts them at greater risk of tooth loss. The findings may aid policymakers in reducing oral health disparity.
“The significant effects of these adverse experiences during childhood on oral health are persistent over and above diabetes and lung disease, which are known to be correlates of poor oral health,” said study author Dr. Haena Lee, a postdoctoral research fellow at the University of Michigan. “But it’s not just these medical conditions that explain your oral function,” she added. “Nearly 20 percent of Americans over age 50 are estimated to live with no teeth, and I want to draw attention to life course histories that can capture some other important pathways to this oral health disparity.”
Lee drew data from the 2012 Health and Retirement Study, a nationally representative longitudinal study of older adults and their spouses in the U.S. It includes a core survey and a supplemental survey and focuses on the participants’ childhood experiences, adult educational attainment and poverty status. Using this data, Lee investigated three models of life course research: the sensitive period, the accumulation model and the social mobility model.
The data showed that more than 13 percent of respondents over 50 had lost all of their permanent teeth. Nearly 30 percent of the participants had experienced financial hardship, had lost their parents or had experienced a parental divorce by age 16. Ten percent of the respondents had experienced physical abuse and 18 percent had smoked during childhood. Nearly half held a high school diploma or a lower level of education, and 20 percent of the respondents had lived in poverty at least once since age 51.
After controlling for adult socio-economic status, diabetes and lung disease, Lee found that childhood trauma and abuse may have a long-term impact on total tooth loss. Additionally, the findings suggest that older adults are at higher risk of total tooth loss if they have consistently experienced adverse events throughout their lives. Lee believes that the aforementioned adverse events could impact tooth loss through socio-behavioral pathways. For example, abused children may be more likely to engage in negative health behaviors, such as binge drinking, excessive consumption of sugar or nicotine use, which in turn, can contribute to tooth loss. Stress could also play an important role in impacting inhibitory control of the brain, which may lead to nicotine dependence. Finally, childhood trauma may have a negative effect on learning and achievement, and people with low educational attainment may be less likely to hold jobs that provide dental insurance, according to the study.
“It’s really sad to say that adversity breeds adversity, but it really seems that dental health is rooted in adverse experiences you encounter over the life course, particularly in childhood,” Lee noted. “Future policy may benefit from considering the role of childhood adversity and beyond to reduce further oral health disparity.”
The study, titled “A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study,” was published online on May 21, 2019, in Community Dentistry and Oral Epidemiology, ahead of inclusion in an issue.